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  Varicose Veins

by Dra. Ángeles Herráiz
published: January 12, 2005

Etología de las varices

In the aetiology of varicose veins, we can mention various factors: bipedestation, heredity, gender –more frequent among women--, menstrual period, pregnancy, obesity, menopause and old age.

Physiology

blood pressureVeins are six to ten times more elastic than arteries. This fact allows for less resistance to the blood flow. Veins carry a larger volume of blood and oppose less resistance to its flow. On the other hand, terminal arteries, arterioles and capillaries carry only 10% of the blood volume and offer more resistance to the blood flow.

The higher blood pressure takes place at the level of the left auricle, aorta and big trunks. The more the arterial branching, the less pressure. The blood reaches the arterial capillary with 35 mm Hg. When the blood goes out from the venous capillaries it reaches only 25 mm Hg. The blood is received into the veins with a pressure of just 15 mm Hg and drains into the right auricle with the lowest pressure of the circulatory system.

Válvulas venosasIn the veins, there is a structure of venous valves. These are membranes with one end joined to the vessel’s wall and the other free. The free end floats and when it joins the opposite valve’s free end guarantees a fast closing. These valves open or close according to the hemodynamic demands influenced by changes in pressure levels.

Varicose veins

Varicose veins are an evolutive degeneration of veins that consists in permanent dilation of the vessel associated to elongation, functional and organic avalvulation and permanent damages in parietal endothelium --the inner layer of the vessel’s wall--.

SCLEROTHERAPY

One of the commonest treatments for varicose veins, telangiectasias and varicules is the sclerotherapy. Before starting this treatment, an exhaustive and systematic visual technique and palpation exam is needed in order to recognize not only varicose veins but also reflux points. This exam should be done on a standing up patient as this is the best position to clearly identify dilated veins for blood pressure. Also a doppler examination should be done in order to discard the existence of thrombi or insuficient valves.

Technique

With this method varicose veins are removed by chemical means with the result of obliteration, which prevents completely the new canalization of veins. This is the most harmless method of all the active treatments for varicose veins, if the indications are well established and the technique is carried out properly.

There are different types of sclerosant agents depending on its potential. The choice will always depend on the type of varicose vein to be treated.

We normally treat one leg in each session if there are enough varicose veins. The sclerosant agent is injected into the vessel’s lumen and immediately a cotton ball and compression tape is applied to the leg. Once the whole varicose area of that extremity is finished, a tight-fitting support hose is prescribed during two days. A week after, we repeat the treatment on the other extremity and so on until the varicose veins have disappeared.

Side effects

Immediately after treatment swelling and pigmentation in the treated area can occur. Systematic compression and puncture of the new thrombus can alleviate this condition immediately.

AMBULATORY PHLEBOTOMY

It is a gentle surgical procedure that removes varicose veins with local anaesthesia.

The surgical procedure consists of four stages:

  • Marking
  • Disinfection
  • Anaesthesia with adrenalized xilocain injected along the mark previously drawn.
  • Surgical procedure: a series of incisions from 1 to 2 mm along the varicose vein. By means of these incisions the vein can be found and removed. Immediately afterwards, the area should be compressed, keeping the compression up to three weeks.

Side Effects

  • Itchy sensation and cramps can occur. Lowering pressure and using a pressure gradient stocking can make it disappear.
  • Pigmentation. It will disappear easily or otherwise could be treated with depigmentation products.

Leer también
Varices por Elena Martínez Gómez

Dra. Ángeles Herráiz es Licenciada en Medicina y Cirugía por la Universidad Complutense de Madrid en su especialidad de medicina estética.

IMA Instituto Médico Aranda
C/ López Aranda 24, 28027 Madrid
(Zona Arturo Soria)
Tel.: 91 320 19 92

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